Flail chest

Flail chest
Other namesParadoxical breathing
A 3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.
SpecialtyThoracic surgery, Trauma surgery
ComplicationsPneumothorax

Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath.[1]

It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. The number of ribs that must be broken varies by differing definitions: some sources say at least two adjacent ribs are broken in at least two places,[2] some require three or more ribs in two or more places.[3] The flail segment moves in the opposite direction to the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called "paradoxical breathing"[4] is painful and increases the work involved in breathing.

Flail chest is usually accompanied by a pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation.[5] Often, it is the contusion, not the flail segment, that is the main cause of respiratory problems in people with both injuries.[6]

Surgery to fix the fractures appears to result in better outcomes.[7]

  1. ^ Cite error: The named reference Athanassiadi, Kalliopi 2004 Pg 373-376 was invoked but never defined (see the help page).
  2. ^ Emergency Nurses Association (2005). Lorene Newberry; Laura M. Criddle (eds.). Sheehy's Manual of Emergency Care (6th ed.). St Louis, Missouri: Elsevier Mosby. pp. 655–657.
  3. ^ Keel M, Meier C (December 2007). "Chest injuries – what is new?". Current Opinion in Critical Care. 13 (6): 674–9. doi:10.1097/MCC.0b013e3282f1fe71. PMID 17975389. S2CID 19317500.
  4. ^ "OVERVIEW paradoxical breathing". Oxford Reference. Retrieved 7 Sep 2013.
  5. ^ Yamamoto L, Schroeder C, Morley D, Beliveau C (2005). "Thoracic trauma: The deadly dozen". Critical Care Nursing Quarterly. 28 (1): 22–40. doi:10.1097/00002727-200501000-00004. PMID 15732422.
  6. ^ Hemmila MR, Wahl WL (2005). "Management of the injured patient". In Doherty GM (ed.). Current Surgical Diagnosis and Treatment. McGraw-Hill Medical. p. 214. ISBN 0-07-142315-X. Retrieved 2008-07-04.
  7. ^ Coughlin, TA; Ng, JW; Rollins, KE; Forward, DP; Ollivere, BJ (August 2016). "Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials". The Bone & Joint Journal. 98-B (8): 1119–25. doi:10.1302/0301-620x.98b8.37282. PMID 27482027.